P.J. Regan

Smoking, Alcohol And The Risk Of Dupuytren's Contracture

We investigated the association of Dupuytrens contracture with smoking and with alcohol by a case-control study in which 222 patients having an operation for this condition were matched for age, operation date and gender with control patients having other orthopaedic operations. Fifty of the cases were also each matched with four community controls. Data were collected by postal questionnaire. Dupuytrens contracture needing operation was strongly associated with current cigarette smoking (adjusted odds ratio 2.8 (95% confidence interval (CI) 1.5 to 5.2)). The mean lifetime cigarette consumption was 16.7 pack-years for the cases compared with 12.0 pack-years for the controls (p = 0.016). Dupuytrens contracture was also associated with an Alcohol Use Disorders Test score greater than 7 (adjusted odds ratio 1.9 (95% CI 1.02 to 3.57)). Mean weekly alcohol consumption was 7.3 units for cases and 5.4 units for controls (p = 0.016). The excess risk associated with alcohol did not appear to be due to a confounding effect of smoking, or vice versa. Smoking increases the risk of developing Dupuytrens contracture and may contribute to its prevalence in alcoholics, who tend to smoke heavily.

Pretibial injuries in the elderly: a prospective trial of early mobilisation versus bed rest following surgical treatment

Pretibial lacerations are a common form of injury of the elderly population. With respect to graft healing, controversy exists regarding rehabilitation by early ambulation, following debridement and split skin grafting. In a prospective, randomised trial comparing early mobilisation (n = 21) with the traditional method of a period of in-patient bed rest after surgical treatment (n = 40), no statistically significant difference has been found in the percentage area of skin graft take at either 1 or 3 weeks postoperatively. The method of anaesthesia (local or general) has no significant effect on the outcome of healing. Prolonged bed rest has a detrimental effect on return to independent mobility in one third of cases. Complications related to the wound site are similar in both groups. Hospital stay averaged 12 days in those confined to bed, compared to an average of 2 days in those who were allowed to walk immediately.

Rupture of Flexor Pollicis Longus as a Complication of Colles’ Fracture: A Case Report:

A case of flexor pollicis longus tendon rupture as a complication of a Colles fracture in a 17-year-old male is described. Tendon repair by means of a one-stage tendon graft produced a good functional result.

Cement burns and their treatment.

Twenty patients with cement burns presenting to Stoke Mandeville Hospital Burns Unit between 1981 and 1989 are described. They represent 1.8 per cent of the total adult patients treated at this unit. Fifteen (75 per cent) had surgery for full thickness skin burns. A questionnaire sent to all the accident and emergency officers employed within the catchment area of the Burns Unit at Stoke Mandeville Hospital showed important gaps in their knowledge of the subject. It is suggested that further publicity be given to this uncommon but potentially serious injury.

First dorsal metacarpal artery flap cover for extensive pulp defects in the normal length thumb

Use of the first dorsal metacarpal artery flap to cover extensive pulp defects in the normal length thumb in five patients is described. The advantages of the procedure include provision of sensate cover of exposed distal phalanx to the tip of the thumb with minimal donor site morbidity. Its use, particularly in the older patient, with immediate postoperative mobilisation and the avoidance of nerve repair or more complicated microsurgical procedures, is discussed.

Ulnar nerve compression caused by a reversed palmaris longus muscle

A case of ulnar nerve compression at the wrist caused by a reversed palmaris longus muscle is reported. We are not aware of any previous reports of ulnar nerve compression due to this particular muscle anomaly.

Accessory palmaris longus muscle causing ulnar nerve compression at the wrist

An accessory palmaris muscle that arose from the base of the fifth metacarpal passed proximally and inserted into the palmaris longus tendon. In its course it compressed the ulnar nerve and vessels. It was detached proximally and folded on itself to provide hypothenar bulk. The entrapment symptoms were relieved.

Forearm Muscle Herniae and their Treatment

Three cases of forearm muscle hernia are described. Their aetiology differed but, in all three, symptoms were sufficiently severe to interfere with the patients work. Surgical repair of the myocoeles, by closure of the fascial defects using lata onlay grafts or an interweave of palmaris longus tendon, produced complete resolution of symptoms and enabled the patients to return to full employment.

Localized nodular synovitis: A rare cause of ulnar nerve compression in Guyon's canal

A rare case of ulnar nerve entrapment at the wrist by a nodule of localized nodular synovitis is presented. The literature is reviewed with particular reference to the causes of ulnar tunnel syndrome, the uncertainty over the origin of this type of tumor, and its tendency to recur after incomplete excision.

Hand injuries from leading horses

An estimated 3.5 million people ride horses in the United Kingdom (Cannon, 1989). Injuries consequent to falls are common (Edixhoven et al., 1981), but those sustained while leading horses are less well recognized. In eight cases inappropriate grip of the reins or halter rope while leading a horse or pony resulted in an avulsion injury to a finger or thumb. It is suggested that people at risk be informed of such injuries.