Virchel E. Wood

Polydactyly and the triphalangeal thumb

Polydactyly associated with triphalangeal thumb is not rare, as among the records of 1,269 patients with congenital deformation of the upper extremity at the University of Iowa there were 21 patients with 32 hands with such involvement. More detailed classification based on Wassels work was made. Treatment should be early, with removal of the radial digit if equal in size, excision of all accessory parts including delta bone when present, reconstruction of joint ligaments or joint fusion and osteotomy for correction of deviations. Care should be taken to avoid leaving a narrow first web space.

The sesamoid bones of the hand and their pathology

Three cases of sesamoid bone pathology are presented, including two cases of sesamoid fracture and a case of sesamoid periostitis. The literature is reviewed. Sesamoid bones probably function in the body as pulleys. Most people have five sesamoid bones in each hand. Two at the thumb metacarpophalangeal joint, one at the interphalangeal joint of the thumb, one at the metacarpophalangeal joint of the index finger on the radial side, and one at the metacarpophalangeal joint of the little finger on the ulnar side. Sesamoid bones have been seen with periostitis in Reiter’s syndrome. The medial sesamoid bone of the thumb metacarpophalangeal is frequently enlarged in acromegaly. The sesamoid bones of the thumb have been fractured or trapped inside the joint during injury to the thumb metacarpophalangeal joint. The treatment of disabling pain in a sesamoid bone is enucleation of the bone.

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.

Treatment of neuromas about a major amputation stump

In five patients, with intractable pain from neuromas that developed after amputations at the wrist or forearm, the neuromas were resected and the median nerve anastamosed to the ulnar nerve under the pronator teres muscle. In one patient, the anterior interosseous nerve was also anastamosed to the superficial radial nerve under the muscles of the forearm. Patients reported an 80% to 90% reduction in pain. This procedure is limited to patients in which all other treatments have failed.

The treatment of metacarpal synostosis

One hundred nine patients with metacarpal synostosis were examined to determine the best treatment for this condition. The fourth and fifth metacarpals are most frequently affected, and bilateral involvement occurs often. Many anomalies are associated with synostosis, as well as many syndromes such as Aperts syndrome, central polydactyly, syndactyly, and partial absence of the hand. An osteotomy to split and separate the synostosis, a bone graft to lengthen the fifth metacarpal, collateral ligament reconstruction, and tendon transposition of the extensor digiti minimi quinti all appear to be valuable for the treatment of this rare congenital anomaly.

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.

The extensor carpi radialis intermedius tendon

I examined 312 arms from 156 cadavers in the anatomy laboratory of Loma Linda University to find the incidence of the extensor carpi radialis intermedius tendon. I found 29 bodies (12%) that had a good extensor carpi radialis intermedius. In 17 of these 29 bodies, an extra tendon was found bilaterally. Thirty-two extensor carpi radialis intermedius tendons were suitable for transfer operations, and seven were unacceptable. One must be careful to differentiate between a true extensor carpi radialis intermedius tendon and accessory tendinous bands. The relatively high incidence rate and percentage of tendons suitable for transfer operations make this tendon potentially valuable in treating severe quadriplegia with tendon transfers. It can be used successfully for thumb opposition, to motor the flexor pollicis longus, or as a motor for the extensor pollicis longus of the thumb.

Small finger pollicization in the radial club hand

This article describes pollicization of the small finger. A procedure that should only be used in the rare instance of an inoperable radial club hand. Children with bilateral radial club hands and severe, fixed radial deviation of the hand at the end of the forearm, and stiff elbows that cannot be mobilized either with a tendon transfer, splinting, or triceps release can be considered candidates for this operation. The technique, as described by Dieter Buck-Gramcko for pollicization of the index finger, was modified to be used in this procedure.

Clinodactyly: An Unusual Presentation

In clinodactyly, or «bent finger», the usual deformity is radial deviation of the little finger at the D.I.P. joint. In this case, the deviation occurred at the P.I.P. and M.P. joints

Different manifestations of hyperphalangism.

Hyperphalangism, characterized by an extra phalanx between the phalanges of a finger is a rare congenital anomaly. Five cases show some of the different manifestations of this rare congenital anomaly. Brachyhyperphalangism can be inherited as an autosomal dominant trait with good penetrance, but can also simply be one manifestation of a group of congenital abnormalities.