Y.C. So

Unstable phalangeal fractures: Treatment by A.O. screw and plate fixation

A prospective study of fifty-two fresh traumatic unstable fractures of the proximal or middle phalanges of the hand in forty-seven patients was reviewed. All the fractures were fixed with A.O. miniature screws and plates. The overall results were not satisfactory and complications were frequent. Only 26.9% of the fractures had good results. Fractures associated with significant soft tissue injuries had very poor results. When the present series was compared with a comparable group of fractures fixed with Kirschner wires, there was no significant improvement in the results. The unsatisfactory outcome of this group of unstable fractures may be largely due to the frequent association with poor prognostic factors.

A Prospective Study of 245 Open Digital Fractures of the Hand

We report a prospective study of 245 open digital fractures of the hand in 201 patients. Management followed clear guidelines set out in protocol. The incidence of infection (2.04%) and non-union (2.45%) was low. Proximal phalangeal fractures and comminuted fractures did worst and associated significant soft tissue injuries had a particularly deleterious effect on the outcome. A classification based on the different soft-tissue components involved is proposed. In fractures associated with simple lacerations or isolated digital nerve injury only, one can expect about 40% good results and about 25% poor results. Where extensor tendon injury or extensive skin loss are also present, there will be approximately 18% good results and 50% poor results. If there is also injury to the flexor tendon or more than one component of significant soft-tissue damage, about 80% will be poor and good results are rare.

Mycobacterium marinum infection of the hand and wrist. Results of conservative treatment in twenty-four cases.

Inadequate débridement, extensive scarring, and breakdown of the wound have been commonly encountered after surgical débridement has been employed as the initial treatment of infection with Mycobacterium marinum involving the deep structures of the hand. Because of our disappointment with the results of this form of treatment, from 1982 to 1986 we treated twenty-four patients who had such an infection with rifampicin and ethambutol after a diagnostic biopsy was done. Surgical treatment was deferred until it was determined that the infection had not been controlled by the chemotherapy. The clinical outcome for these patients could be divided into three patterns: eleven patients (Group I) had a good result with no complications, three patients (Group II) had delayed healing of the wound, and ten patients (Group III) did not have a good response to conservative treatment and required one or more surgical débridements. Complications were sometimes associated with use of the drugs, and loss of visual acuity was a concern in three patients. In twenty-one (87 per cent) of the patients, at follow-up the function of the treated hand was equal to that of the other hand. Persistent pain, a discharging sinus, and previous local injection of steroids were unfavorable prognostic factors. If these factors are present, surgical débridement is advised.

Evaluation of results in flexor tendon repair: A critical analysis of five methods in ninety-five digits

The development of an internationally accepted system of assessment of results after flexor tendon repair is important. In a prospective study of ninety-five digits, gross discrepancies were demonstrated between five popular methods of assessment: Buck-Gramcko, linear measurement, Grossman, American Society for Surgery of the Hand, and Strickland. The relative merits of each systems were studied and modifications for the Buck-Gramcko system are suggested.

Varus deformity following lateral humeral condylar fractures in children.

Lateral humeral condylar fractures are quite common in children. This article shows that varus deformity is a common sequela following such injuries. Twenty-four patients were studied, with a mean follow-up of 4.8 years. A loss of carrying angle, seen in 10 cases, occurred with comparable frequency in undisplaced (50%) and displaced (39%) fractures. The deformity was usually mild, averaging 10° in the undisplaced fractures and 9.6° in the displaced fractures treated with open reduction. We conclude that varus deformity is common in this injury, and occurs whether or not the fracture is displaced.

An unusual association of the windblown hand with upper limb hypertrophy

An eight-year-old boy presented with a congenital windblown hand deformity associated with partial hypertrophy of that arm. Many of the classical features of the windblown hand syndrome described in previous papers were absent. In this case, the primary cause of the ulnar-drift deformity was an anomalous epiphysis at the base of the second metacarpal. Surgical correction was readily obtained by osteotomy at the base of the metacarpal combined with soft tissue re-alignment.

Thenar crush injuries

Crushing of the radial side of the hand results in a wide spectrum of injuries varying from contusion of muscles to total loss. The main problem concerns the function of the thumb. The results of such injuries in 161 hands were reviewed. Those with mild injuries treated conservatively or by debridement alone had good results. When skin flaps were required for wound coverage, the results were still satisfactory. However, when bones and joints were injured, the results were poor. In certain patients opponensplasty through scarred tissue proved to be a good procedure to improve the function of the thumb.

Sequential Forearm Intravenous Regional and Infiltration Anaesthesia: Value for Haemostasis

Intravenous regional anaesthesia using 0.5% lignocaine with a forearm tourniquet is a satisfactory technique for operations on the distal forearm, wrist and hand. Since recovery of pain sensation is rapid, haemostasis after release of tourniquet becomes difficult and sometimes impossible. Local wound infiltration or metacarpal block with 1% lignocaine just before release of the tourniquet can allow subsequent haemostasis and wound closure to be carried out without causing pain. 55 patients received this sequential forearm intravenous regional and infiltrative anaesthesia. Subsequent haemostasis and wound closure could be carried out without pain in 51 patients (92.7%); three patients (5.5%) noticed mild discomfort but the operations could be finished without any additional anaesthetic agent. No complications were encountered with this modified technique.