Vaikunthan Rajaratnam

Proximal interphalangeal joint fractures of the hand. Treatment with an external dynamic traction device

The authors present a series of 11 consecutive patients who sustained an intra-articular fracture of the proximal interphalangeal (PIP) joint and 1 patient with a fracture of the interphalangeal joint of the thumb treated with a Kirschner wire external dynamic traction device. Range of motion and grip strength were measured. We used the Michigan Hand Outcome Questionnaire (MHQ) to obtain a subjective response to the treatment. Average range of motion of the PIP joint was 64° and distal interphalangeal joint was 52°. The average grip strength was 86% with a mean MHQ score of 90. Two patients had pin site infections treated successfully with antibiotics. All fractures had united at final follow up with <1-mm articular step present. Our series highlights that these are difficult injuries to treat and that anatomic reduction is not always possible. However, this technique is simple and quick to perform while allowing early joint mobilization. The subjective response to treatment is comparable with other studies using a similar device.

Biomechanical comparison of pull-out force of unicortical versus bicortical screws in proximal phalanges of the hand: a human cadaveric study.

BACKGROUND Bicortical fixation of proximal phalangeal fractures may damage underlying flexor tendons secondary to drilling and screw protrusion in the dorsal-ventral direction. The aim of this study was to measure and compare the pull-out force of unicortical screws compared to bicortical screws in human cadaveric proximal phalanges to identify optimal configuration for internal fixation. METHODS Forty proximal phalanges were harvested. Bicortical and unicortical self tapping 1.7mm screws were inserted into paired phalanges at the distal and proximal metaphysis and at the mid-diaphysis placed in the dorso-ventral direction. Pull-out force of unicortical and bicortical screws were measured and compared. FINDINGS Bicortical screw pull-out force is significantly higher than that of unicortical screws in the dorsal-ventral direction. Pull-out strength of unicortical screws at the mid-diaphysis was significantly higher than the pull-out strength of bicortical screws at the proximal metaphysis (181.8N versus 31.5N, P<0.0001). INTERPRETATION Diaphyseal fixation is stronger than metaphyseal for both unicortical and bicortical configurations. Unicortical mid-diaphyseal is stronger than bicortical proximal metaphyseal screw pull-out strength. This study provides biomechanical data that may be helpful for individualizing fracture fixation techniques at the proximal phalanx.

Using LinkedIn for Continuing Community of Practice Among Hand Surgeons Worldwide.

Background: Hand surgeons need continuing professional development due to rapid advancement in the field. Traditional approaches have proven to be challenging due to the nature of surgical practice and other demands. Social media sites have shown the potential to build an online community of practice. Methods: One of the authors (VR) started Hand Surgery International on LinkedIn in February 2011. Results: The number of members increased from 38 in the beginning to 4106 members by August 13, 2015, with members from all over the world. Half of them are from plastic surgery, with 16.8% hand and 17.8% orthopedic surgery; 63.8% of them are consultants. There were 151 discussion topics, which generated 1238 comments at an average of 8.2 comments per discussion thread. The topics focused on management of difficult patients, seeking consensus, and searching information. The features participants found most useful included case‐based discussion, polls/surveys, and network opportunity. Members perceived the LinkedIn community as user‐friendly and easy to use. It does not require significant technical knowledge. For the question “How would you rate the overall ease of using this platform?” 42% answered “strongly agree” and 37% “agree”. Conclusion: The LinkedIn group serves as an effective means for continuing professional development for hand surgeons.

Traumatic correction of Linburg-Comstock anomaly: a case report.

Linburg-Comstock anomaly describes an anatomical variant of flexor tendons of the hand. Flexor pollicis longus (FPL) sends a connecting tendon to flexor digitorum profundus (FDP), causing simultaneous flexion at the distal interphalangeal joint (DIPJ) of the index finger when the interphalangeal joint (IPJ) of the thumb is flexed. Epidemiological studies have revealed a unilateral prevalence as high as 31% of individuals; however, the condition rarely causes symptoms. The anomaly can present with a restrictive flexor tenosynovitis, requiring explorative surgery to confirm the diagnosis and disconnection of the anomalous tendon slip to relieve symptoms. We describe the case of a rock climber who suffered a forced extension injury to the DIPJ of the right index finger, resulting in traumatic rupture of his anomalous FPL-FDP connecting tendon. This is the first reported case of rupture of a Linburg-Comstock anomaly. Through rupture of this anomalous tendon, the patient can be viewed as having corrected his aberrant tendon to conform with the more prevalent anatomical configuration and function. We identified the rupture using dynamic ultrasound of the wrist; to our knowledge, this technique has not been described previously in the literature. We recommend the use of this imaging modality to confirm diagnosis, thus avoiding explorative surgery.

High-resolution ultrasound in the diagnosis of upper limb disorders: a tertiary referral centre experience.

The purpose of this study is to determine the reliability of high-resolution ultrasound (HRUS) in the diagnosis of upper limb disorders compared with the initial clinical opinion. We prospectively studied 178 patients referred for HRUS examination (47.2% hand, 34.8% wrist, and 18% elbow examinations) by recording the clinical opinion, the specific ultrasound diagnosis, and the final diagnosis, as established by surgery (79.9%) or follow-up (20.1%). HRUS examination was highly reliable in diagnosing cystic lesions, synovial disease, ligament injury and foreign bodies (100%), and slightly less reliable for solid lesions (82.1%) and nerve, bone, and tendon disorders (97%, 91.7%, 86.5%, respectively). HRUS examination resulted in significantly more correct diagnoses (92.1%) than the clinical opinion (70.8%) (McNemar test, P = 0.001). The agreement between the HRUS diagnosis and the clinical opinion was slight (Kappa test, k = 0.16). HRUS examination is more reliable than clinical examination in diagnosing upper limb disorders.

A biomechanical analysis of distraction force in modified hynes-giddins dynamic external fixator

Hynes and Giddins modified the rubber band traction device advocated by Suzuki for management of phalangeal pilon fractures and fracture-dislocations. We present here a modification of the Hynes-Giddins version of this dynamic external fixator, which allows alteration of the distracting force by a simple adjustment of the construct.

Post-traumatic false aneurysm in a digital artery of the finger

Abstract Despite the high incidence of trauma involving the hand and digits, traumatic aneurysms in this region are rarely seen and few are reported. We describe a false aneurysm of a digital artery caused by a dog bite.