James N. Wilson

Flexor-tendon Ruptures in the Forearm and Hand

Eighty ruptures of flexor tendons, occurring over a thirteen-year period in the fingers in seventy-eight patients, were studied. The tendons involved were the flexor digitorum profundus, flexor digitorum sublimis, and flexor pollicis longus. The majority of ruptures occurred in young patients, suggesting that degenerative changes accompanying aging were not directly responsible for rupture. The force producing the rupture was often slight, indicating that some underlying factors had already predisposed the tendon to rupture. Flexor-tendon ruptures were found to occur most frequently after crushing injuries, lacerations, hyperextension injuries, and as the result of forced flexion against resistance. In 67.9 per cent of the tendons, these ruptures were found at the insertion or musculotendinous junction. In 31.9 per cent, they occurred within the tendon substance. Hyperextension injuries most often produced ruptures at the insertion. Lacerations and crushing injuries were also frequently followed by rupture of a flexor tendon at its insertion or elsewhere within the finger. Ruptures resulting from forced flexion against resistance produced injuries at the tendon insertion, except in those instances where the tensile strength of the tendon had been decreased by pathological changes. In 20 per cent of all the ruptures, pathological changes in the tendon accounted for rupture and in nearly all of the tendons with these changes the ruptures occurred in the palm, carpal tunnel, or wrist. It is emphasized that surgical treatment is often unnecessary. Surgery is essential only when flexor function has been severely compromised or lost.

Epiphyseal Transplantation: A Clinical Study

1. Eleven cases of autogenous epiphyseal transplantations to the hand and forearm are presented. In all cases, the epiphysis was transplanted as a free graft. 2. In one patient there was definite evidence of growth eight years after transplantation of a proximal phalanx. In two other cases, there was some evidence of growth two years after transplantation. 3. The reasons for success or failure following epiphyseal transplantation are not apparent. Continued investigation seems warranted.

Fracture-dislocation of the proximal interphalangeal joint of the finger.

1. Fracture-dislocations of the proximal interphalangeal joint of a finger results in marked damage to the joint most needed for good function of the finger. Extensive articular destruction is frequently present and is not visualized by standard roentgenograms. 2. Maximum restoration of joint motion can best be achieved by anatomical restoration of joint contour and alignment. 3. We believe that early open reduction and internal fixation, skillfully performed, is the best method to restore maximum function.

Grease-gun Injuries of the Hand

Grease-gun injuries are an undesirable side effect of our modern machine age. Since methods of high-pressure lubrication are used in automobile, airplane, and missile industries, more such injuries can be expected. The seriousness of these injuries should be recognized so that prompt and adequate treatment can reduce the resulting disability. Grease-gun injuries of the hand are best treated by immediate surgical removal of as much of the grease as possible. This will prevent ischemic gangrene and reduce fibrosis and scarring.

Providing automatic grasp by flexor tenodesis.

Fusion of the wrist. has l)een a romti only accepted orthopaedic procedure for maiiy ‘ears. The principle of stabilization of the joint to overcome paits is tsot subject. to enticism in most. cases. In paralytic upper extremities, however, wrist stabilizatiots should l)e subjected to close scrutitsy. The pnitnary aim of this paper is to familiarize the reader ith a method of treating paralytic hands which relies tipots the preservation of wrist mol)ility for its effectivetsess. By this method sotsse degree of fuisctiois can frequently be restored. Ati autoissatic tuechattistu which pnovi(les the basic functioiss of grasp and pinch can be obt.aitsed if the patient. possesses voluntary dorsiflexion of the wrist. The functioning of this automatic mechatsism can be observed in the normal hand (Fig. 1). When the wrist is allowed to be palmar flexed by gravity, the fingers and thumb extend and the hand opens. \Vhen the wrist is dorsiflexed, the fingers flex to form a weak grasp and the thumb approximates the side of the iisdex finger to provide pinch. The motions observed can occur its the complete absence of any voluntary activation of the digits and

PROFILES OF THE CARPAL CANAL

The author wishes to emphasize the importance of the profile view in identifying certain injuries and developmental disturbances of the carpus, since it is clear that standard roentgenographic views of the wrist do not reveal some of the fine details of carpal bones.

Full-Thickness Sole-Skin Grafts for Resurfacing the Hand

1. Free full-thickness skin grafts from the sole of the foot have been used to resurface thirteen defects on the volar surface of the hand in eleven patients. 2. The cosmetic, as well as the functional, aspect of the sole grafts appears to be far superior to other types of free skin grafts. 3. The donor site on the sole of the foot has been resurfaced with a free fullthickness skin graft from the inguinal area. 4. There has been no significant disability due to the scars or the grafts on the feet in our series of cases.